An Interesting Case and Literature Review of a Coronary Stent Fracture in a Current Generation Platinum Chromium Everolimus-Eluting Stent

Aung, Sammy San Myint; Latt, Htun; Kyaw, Kyaw; Roongsritong, Chanwit

doi:10.1155/2018/4579184

Cited by 4 publications

(5 citation statements)

References 16 publications

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“…A recent U.S. Food and Drug Administration (FDA) report corroborated that metal implants experience wear and corrosion due to the mechanical and biochemical environment at the implantation site . The report also summarized the findings of other studies − pointing out that biocorrosion is a limiting design constraint on cardiovascular implant longevity as it presents the risk of deterioration of the material’s mechanical properties that could predispose fatigue fracture or trigger the release of debris. Nanometer-thick regions of the protective oxide layer are lost under complex in vivo conditions such as vessel tortuosity, high curvature, the vascular wall stresses as well as blood flow wall shear stresses, and diffuse calcification, creating a conduit for exposure of the metal ion-rich phases to the in vivo environment. ,− These conditions may compound their effects when two or more overlapping devices are deployed, , a common clinical practice in interventional procedures, especially in areas of branches and bifurcations or when treating long or recurrent lesions.…”

Section: Introductionmentioning

confidence: 94%

“…18 , 24 − 26 These conditions may compound their effects when two or more overlapping devices are deployed, 27 , 28 a common clinical practice in interventional procedures, especially in areas of branches and bifurcations or when treating long or recurrent lesions. Several studies of implant retrievals from cadavers or retrospective cohort analyses, 21 − 24 , 26 , 31 , 32 indicate significant device failure not consistent with the original estimates of the manufacturers. Surface alterations, comparable with corrosion mediated by electrochemical and mechanical factors, were observed in explanted stents, but most importantly, tissue dissolved around corroded stents corresponded with a higher metallic content.…”

Section: Introductionmentioning

confidence: 96%

“…Nanometer-thick regions of the protective oxide layer are lost under complex in vivo conditions such as vessel tortuosity, high curvature, the vascular wall stresses as well as blood flow wall shear stresses, and diffuse calcification, creating a conduit for exposure of the metal ion-rich phases to the in vivo environment. ,− These conditions may compound their effects when two or more overlapping devices are deployed, , a common clinical practice in interventional procedures, especially in areas of branches and bifurcations or when treating long or recurrent lesions. Several studies of implant retrievals from cadavers or retrospective cohort analyses, − ,,, indicate significant device failure not consistent with the original estimates of the manufacturers. Surface alterations, comparable with corrosion mediated by electrochemical and mechanical factors, were observed in explanted stents, but most importantly, tissue dissolved around corroded stents corresponded with a higher metallic content.…”

Section: Introductionmentioning

confidence: 97%

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Multilevel Assessment of Stent-Induced Inflammation in the Adjacent Vascular Tissue

Kapnisis

Stylianou

Kokkinidou

et al. 2023

ACS Biomater. Sci. Eng.

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A recent U.S. Food and Drug Administration report presented the currently available scientific information related to biological response to metal implants. In this work, a multilevel approach was employed to assess the implant-induced and biocorrosion-related inflammation in the adjacent vascular tissue using a mouse stent implantation model. The implications of biocorrosion on peri-implant tissue were assessed at the macroscopic level via in vivo imaging and histomorphology. Elevated matrix metalloproteinase activity, colocalized with the site of implantation, and histological staining indicated that stent surface condition and implantation time affect the inflammatory response and subsequent formation and extent of neointima. Hematological measurements also demonstrated that accumulated metal particle contamination in blood samples from corroded-stetted mice causes a stronger immune response. At the cellular level, the stent-induced alterations in the nanostructure, cytoskeleton, and mechanical properties of circulating lymphocytes were investigated. It was found that cells from corroded-stented samples exhibited higher stiffness, in terms of Young’s modulus values, compared to noncorroded and sham-stented samples. Nanomechanical modifications were also accompanied by cellular remodeling, through alterations in cell morphology and stress (F-actin) fiber characteristics. Our analysis indicates that surface wear and elevated metal particle contamination, prompted by corroded stents, may contribute to the inflammatory response and the multifactorial process of in-stent restenosis. The results also suggest that circulating lymphocytes could be a novel nanomechanical biomarker for peri-implant tissue inflammation and possibly the early stage of in-stent restenosis. Large-scale studies are warranted to further investigate these findings.

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Section: Introductionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Multilevel Assessment of Stent-Induced Inflammation in the Adjacent Vascular Tissue

Kapnisis

Stylianou

Kokkinidou

et al. 2023

ACS Biomater. Sci. Eng.

View full text Add to dashboard Cite

show abstract

“…In the past, OCT machines lacked 3D imaging tools and OCT cross-sectional images were not associated with obvious advantages in SF. The emergence of OCT 3D real-time reconstruction systems enables the use of OCT to study the occurrence of SF and its clinical significance ( 30 , 71 ). 3D OCT may help diagnose SF and determine the effect of SF on local endometrial repair and local external stent plaque.…”

Section: Application Of Oct In the Post-stent Implantation Follow-upmentioning

confidence: 99%

Advantages and prospects of optical coherence tomography in interventional therapy of coronary heart disease (Review)

Wang

Yuan

et al. 2022

Exp Ther Med

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Coronary heart disease is the leading cause of mortality among all diseases globally. Percutaneous coronary intervention (PCI) is a key method for the treatment of coronary heart disease. Optical coherence tomography (OCT) is an optical diagnostic technology with a resolution of up to 10 µm, which is able to accurately assess the composition of the coronary arterial wall and determine the characteristics of atherosclerotic lesions. It is also highly consistent with pathological examinations, optimizing the effect of stent implantation and evaluation of the long-term effectiveness and safety of the stent, which has irreplaceable value in the field of precision and optimization of coronary intervention. The innovative OCT technology may help provide more comprehensive clinical research evidence. The application of OCT in clinical and basic research of coronary atherosclerosis, selection of treatment strategies for acute coronary syndromes, optimization of interventional treatment efficacy, evaluation of novel stents, intimal stent coverage and selection of dual antiplatelet drugs has become more widely used, affecting the current coronary interventional treatment strategies to a certain extent. The aim of the present review was to discuss the role of OCT in evaluating preoperative plaque characteristics, guiding PCI and evaluating the effects of postoperative stents or drug treatments.

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“…This rate exceeds the reported rate in living patients, which ranges from 0.5% -19% [3][4][5] suggesting this discrepancy may be due to difficulties in obtaining clear, high-quality images of wire stents. If left undetected in the coronary artery, fractured stents can cause restenosis, thrombolysis, acute coronary syndrome, or sudden death 6,7 . Enhancing stent visibility during angioplasty when using injected contrast, and improving visibility post-procedure without contrast, could reduce the high rate of restenosis and fractured/collapsed stents.…”

Section: Introductionmentioning

confidence: 99%

Enhancing bare metal stent visibility using multi-energy subtraction x-ray imaging

Garland¹,

Holdsworth²,

Cunningham³

2023

Medical Imaging 2023: Physics of Medical Imaging

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Angioplasty is an interventional treatment for blood vessel stenosis, that uses a catheter navigated to obstructed vasculature under fluoroscopy to force open the blockage with a balloon or permanent wire stent. Accurate stent placement is critical to avoid stent shifting and enabling new blockages. Unfortunately, background structures such as bone and tissue interfere with stent visualization during angioplasty, making it difficult for physicians to visualize stents during placement and post-operative checkups. This contributes to the 25% restenosis rate in patients with permanent stents1. Multi-energy subtraction angiography (ESA) with fast kV switching may enhance nickel-stent visualization by suppressing background structures. The objective of this work was to develop an ESA protocol to enhance the visualization of nickel wire stents. The signal-to-noise ratio of nickel for a given radiation exposure was simulated using MATLAB® and validated against images of a deployed nitinol stent overlaid on a chest phantom. The stent was isolated from bone or soft tissue by applying a calculated weighting factor to the low energy image. We found that by manipulating the weighting factor, it is possible to selectively remove anatomical structures obstructing the view of the stent.

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An Interesting Case and Literature Review of a Coronary Stent Fracture in a Current Generation Platinum Chromium Everolimus-Eluting Stent

Cited by 4 publications

References 16 publications

Multilevel Assessment of Stent-Induced Inflammation in the Adjacent Vascular Tissue

Multilevel Assessment of Stent-Induced Inflammation in the Adjacent Vascular Tissue

Advantages and prospects of optical coherence tomography in interventional therapy of coronary heart disease (Review)

Enhancing bare metal stent visibility using multi-energy subtraction x-ray imaging

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